Abstract

Introduction: To present a clinical picture and management of goitre patients with acute respiratory failure.
Material and methods: A total of 7,356 patients were operated on between 2000 and 2011 for various goitres, including 1,214 (16.5%)
retrosternal or mediastinal types. Eight (0.1%) patients (six women and two men aged 61–84, mean 76.9 years) presented with acute
respiratory failure on admission. Seven patients were intubated on admission, and one showed severe dyspnoea at rest accompanied by
symptoms of peripheral cyanosis.
Results: Giant retrosternal goitres were found in the eight operated patients. In two cases, the goitre was recurrent in character, and another
two patients had previously suffered from hyperthyroidism (one treated pharmacologically, and one using J131). X-ray examination revealed
tracheostenosis in all patients. No disorders in thyroid function was observed. Preoperative unilateral paralysis of laryngeal recurrent
nerve was found in three patients. The operations were considered as most urgent. Four goitres were neoplastic: two were anaplastic
carcinoma, one was follicular cell carcinoma and one was squamous cell carcinoma. These patients received partial resection to enable
reduction of the goitre mass. In three patients, tracheostomy was necessary. On the other hand, four patients with non-malignant goitres
underwent complete resection (one patient), nearly complete resection (two), and complete resection of one lobe and partial resection of
the other (one). Three patients required mechanical ventilation postoperatively. Two of them, referred to the Intensive Therapy Unit, died
from acute circulatory failure on day 6 and day 10 postoperatively. The rest were discharged in good general condition.
Conclusions:1. Acute respiratory failure caused by a giant goitre is a life-threatening condition that almost always requires an emergency intubation.
2. Due to a high risk of complications and high mortality, patients with acute respiratory failure caused by giant goitres should be operated
in hospitals that are very experienced not only in thyroid but also in mediastinal surgery. (Endokrynol Pol 2013; 64 (3): 215–219)

Abstract

Introduction: To present a clinical picture and management of goitre patients with acute respiratory failure.
Material and methods: A total of 7,356 patients were operated on between 2000 and 2011 for various goitres, including 1,214 (16.5%)
retrosternal or mediastinal types. Eight (0.1%) patients (six women and two men aged 61–84, mean 76.9 years) presented with acute
respiratory failure on admission. Seven patients were intubated on admission, and one showed severe dyspnoea at rest accompanied by
symptoms of peripheral cyanosis.
Results: Giant retrosternal goitres were found in the eight operated patients. In two cases, the goitre was recurrent in character, and another
two patients had previously suffered from hyperthyroidism (one treated pharmacologically, and one using J131). X-ray examination revealed
tracheostenosis in all patients. No disorders in thyroid function was observed. Preoperative unilateral paralysis of laryngeal recurrent
nerve was found in three patients. The operations were considered as most urgent. Four goitres were neoplastic: two were anaplastic
carcinoma, one was follicular cell carcinoma and one was squamous cell carcinoma. These patients received partial resection to enable
reduction of the goitre mass. In three patients, tracheostomy was necessary. On the other hand, four patients with non-malignant goitres
underwent complete resection (one patient), nearly complete resection (two), and complete resection of one lobe and partial resection of
the other (one). Three patients required mechanical ventilation postoperatively. Two of them, referred to the Intensive Therapy Unit, died
from acute circulatory failure on day 6 and day 10 postoperatively. The rest were discharged in good general condition.
Conclusions:1. Acute respiratory failure caused by a giant goitre is a life-threatening condition that almost always requires an emergency intubation.
2. Due to a high risk of complications and high mortality, patients with acute respiratory failure caused by giant goitres should be operated
in hospitals that are very experienced not only in thyroid but also in mediastinal surgery. (Endokrynol Pol 2013; 64 (3): 215–219)

Keywords

Authors

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